Guidelines for Donations

Organ donors may be living, brain dead, or dead via circulatory death. Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked". There's no age limit to donation or to signing up. People between the age of 18 and 60 should consider themselves potential donors.

 There are two types of organ donors:

• Living: A living organ donor is someone who donates a kidney or partial liver to another person; usually a relative or close friend who has end stage kidney disease or liver failure.
• Cadaveric or Deceased: Deceased donors (or cadaveric) are people who have been declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be excised for transplantation.

Living donors potentially can donate:

• One of two kidneys
  A kidney is the most frequently donated organ from a living donor. The donor's remaining kidney provides the necessary function needed to remove waste from the body.

• Part of liver
  Cells in the remaining lobe of the liver grow or regenerate until the liver is almost its original size. This re-growth of the liver occurs in a short period of time in both the donor and recipient.

• Bone Marrow
  A healthy body can easily replace some tissues such as bone marrow or stem cells. Bone marrow can even be donated more than once since it is regenerated and replaced by the body after donation.

Deceased organ donors can donate:

• Liver
  Deceased donor liver transplantation is nowadays a routine procedure for the treatment of terminal liver failure and often represents the only chance of a cure. Under given optimal conditions excellent long-term results can be obtained with 15-year survival rates.

• One or both kidneys
  Deceased kidney donors are most often individuals who die from accidents, heart attacks or strokes, and their next of kin consent to organ donation.

• Pancreas
  The pancreas is usually transplanted together with a kidney in patients with end stage diabetes mellitus and renal failure.

• Heart & Lungs
  A heart-lung transplant is a major operation to replace a person's diseased heart and lungs with those from a donor. It's offered to people with both heart and lung failure when all other treatment options have failed.

• Heart valves
  Human heart valves mainly come from deceased tissue and organ donors. Damage to heart valves may be caused by hardening of the arteries, heart attacks or infections. When used in young patients, these donated heart valves can actually “grow” with the recipient and reduce the need for repeated surgeries.

• Tissues
  Donated tissues save or dramatically improve the quality of life for the people who receive them. As an organ and tissue donor, you can enhance the lives of up to 50 people. Most people who are unable to donate their organs when they die can usually be tissue donors. This is because many of the restrictions that apply to organ donation do not apply to tissue donation.

• Corneas
  You can also leave behind the 'gift of sight' by registering as a cornea donor. Most people can donate their corneas. Exceptions include people with infections or a few highly communicable diseases such as HIV or hepatitis.

The process of deceased donation begins with a decision. You decide you want to help save people with end-stage organ disease by donating your organs when you die. When your time comes, perhaps decades later, your organs may be used to save many lives. Signing up as a deceased donor is generally done years before a person’s death. After the death, the donor’s registry is searched to see if the deceased had enrolled as a donor. If so, that will serve as legal consent. If there is an absence of registry or any other legal consent the team will seek consent from the family. When consent is obtained, medical evaluation occurs, including obtaining the deceased’s complete medical and social history.
 
Even though cases vary, the following describes the basic steps in donation from deceased donors:

• Intensive Care of Potential Donors
  For someone to become a deceased donor, he or she has to die in very specific circumstances. Most often, a patient comes to a hospital because of illness or accident, such as a severe head trauma, or stroke. The patient is put on artificial or mechanical support, which keeps blood with oxygen flowing to the organs. The medical team does everything possible to save the patient's life. At this point, whether or not the person is a registered donor is not considered. Meanwhile, the hospital notifies the PHOTA about the potential donor whose body is supported by artificial means.

• Brain Death Testing
  In the event of accident or medical emergency, even though the medical team members do everything they can to save the patient's life, sometimes the injuries or medical conditions are too severe and the patient dies. If the patient is not responding, an independent team of doctors will perform a series of tests to determine if brain death has occurred. A patient who is brain dead has no brain activity and cannot breathe on his or her own. Brain death is irreversible. Someone who is brain dead cannot recover. Only after brain death has been confirmed and the time of death noted, can organ donation become a possibility.

• Evaluation & Authorisation
  After the patient’s medical evaluation, our representatives search to see if the deceased is registered as a donor on the PHOTA registry. If so, that will serve as legal consent for donation. The donation decision is easier if the family has previously discussed donation. If the deceased has not registered, and there was no other legal consent for donation, our representatives will ask the next of kin for consent/authorisation. The patient’s family takes time to think and ask questions before they decide.

The Punjab Human Organ Transplantation Authority (PHOTA) and hospital work together as a team to support the family and honour the patient’s wishes.

• Organ Matching Criteria
  The Punjab Human Organ Transplantation Authority (PHOTA) operates the provincial database of all patients awaiting transplant. Through our highly sophisticated computerised system that matches donors and recipients, we obtain a match list of recipients for the donor and arrange a transplant surgeon for organ transplant. Each available organ is offered to the transplant team of the best-matched patient. The organ allocation and distribution system is blind to factors such as gender, social or wealth status of the recipient. The amount of time it takes for a person to receive a transplant really depends on a number of medical factors including blood type, severity of illness, time on waiting list and other medical criteria.

Once procured, the organs are transported by PHOTA representatives to the transplant hospitals where most needy and suitable patients are waiting for them. The donor is treated with honour and respect throughout the donation. All incisions are surgically closed. Besides coffin, shroud, flowers, grave, and transportation service, each deceased donor receives official salutation and is buried with full honours.

First, you need to register yourself as potential recipient with the Punjab Human Organ Transplantation Authority (PHOTA) for a deceased donation or find a living donor (who can only be an adult family member). Then you need to visit a registered transplant hospital near you. The hospital's doctors will examine you and decide if you are a good transplant candidate. In addition to criteria developed for organ donation by PHOTA, each transplant hospital has its own criteria for accepting candidates for transplant. If the hospital's transplant team determines that you are a good transplant candidate, they will add you to the provincial waiting list, or refer your case to us if you have a living donor. 
 
The decision to allow a patient get transplanted is taken on a case-by-case basis, depending on the benefits and risks associated with the quality of the organ and the circumstances of the individual. Information about the type of organs that may become available for transplantation and the implications of either waiting for a more suitable organ or deciding to undergo transplantation is communicated early in the process of potential recipient evaluation and authorisation.

 Eligibility Criteria

To be eligible for organ transplantation, patients must meet the relevant eligibility criteria as specified in the Punjab Human Organ Transplant Act 2012. In both cases of living or deceased organ donation, decision-making regarding transplantation must involve explicit evaluation of the risk and benefits to the potential recipient as well as the need to ensure the appropriate use of scarce health resources. 

Decisions regarding eligibility and allocation will take into account the following factors:

• The urgency of the patient’s medical needs
• How long the patient has been waiting for a transplant
• Medical factors which affect likelihood of success